Study 329: 50 Shades of Gray

Editorial Note: None of these posts about Study 329 should be taken as representative of a RIAT view, especially this one. See Study 329: Conflicting Interests for a prequel to this post and to make sense of the last comment.

Fiona Godlee to RIAT July 6 2015
Re: Study 329

Dear Dr Jureidini,

“Many thanks for your letter. I quite understand you concerns. You are right to say that there are few or no precedents against which to compare this article. We ourselves are feeling our way, both with the RIAT process since this is the first full RIAT research paper we will publish, and with the specific challenges posed by this particular study and you as the paper’s authors. I want to stress that we are proceeding in good faith with the clear aim of publishing the article as soon as possible provided we can do so safely”. …

All best wishes

Fiona Godlee FRCP
Editor-in-Chief The BMJ

In utero

The editor dealing with Study 329 through its year-long gestation in the belly of the BMJ was Elizabeth Loder. The paper improved considerably during this time but there was almost nothing constructive from BMJ that led to any of these improvements – readers can examine for themselves the various letters, reviews and revisions, bearing in mind that from our side the correspondence is written under constraint . Indeed almost all inputs from BMJ produced outcomes that likely made the editorial staff ever more uncomfortable.

As the features of Study 329 took shape in the BMJ womb, the New England Journal of Medicine (NEJM) had a series of articles suggesting that concerns about Conflict of Interest had gone too far. Some journals, NEJM said, were in a state of moral panic; they were hunting for witches. They should have run their articles at Halloween.

The BMJ in an editorial by Elizabeth Loder and Fiona Godlee led the way in responding with outrage to the NEJM, suggesting that this was not the time to step back from seeking transparency on conflicting interests. [http://press.psprings.co.uk/bmj/june/COIeditorial.pdf]. Ideally we need to go further and find ways to bring non-financial conflicts of interest into the frame. The medical literature is clearly still a mess and this can only be because we have not been zealous enough about conflicting interests.

The alternate view, not popular with some “progressives” who don’t do science, is that access to data is more important than access to information about conflicts of interest. It is only when there is access to the data that we can see if interests are conflicting and take that into account. Science needs conflicting interests – financial and non-financial. Problems don’t get solved unless someone is motivated for some reason. We need the bias that pharmaceutical companies bring to bear in their defense of a product, along with the bias of those who might have been injured by a treatment. Both of these biases can distort the picture but it’s when people with differing points of view agree on what is right in front of their noses that we can begin to have some confidence about what we have.

Outsiders have conflicts; Insiders don’t

Sixteen years ago I sent a paper to BMJ based on Lilly documents that had come into the public domain because of a Court Case. BMJ’s initial response was that they should perhaps publish given that they had published a Lilly article, the Beasley et al 1991 article, that had done a good deal to create the antidepressant and suicide problem. But Richard Smith resiled from this position. In later correspondence, he stated BMJ would never publish anything from me on this topic.

The real issue was that BMJ were lily-livered and were prepared to cite my supposed conflicts as their escape route even though the data was fully in the public domain and publishing would have laid bare whether my judgments were unduly conflicted. Another journal took the paper promptly.

At the time of the July 6 email above, BMJ stated they were thinking about sending parts of our material out to a third party to review. In fact they had already sent the material out for review when they told us they were thinking about doing so. We objected and made it clear that this was unacceptable and when the reviews came back, we paid little heed to them.

On July 8, we emailed BMJ raising issues covered below.

A headache

Some of the drama in Restoring Study 329 centered on headaches. GSK coded headaches and dizziness one way in the original Study Report and a different way in the Keller et al paper. Headaches and dizziness were so common that moving them from Body as a Whole to Nervous System laundered out the signal not just from suicide events (coded as emotional lability) but from pretty well all psychiatric events.

We were less interested in the question of where exactly headaches and dizziness should be placed and much more interested to make sure readers of the article were aware that it was possible to move them around and in so doing to “re-author” the findings. Our concern wasn’t to show that deception had happened but rather to show how people might be misled – perhaps inadvertently.

Elizabeth Loder was upset. She might have regarded our approach as cavalier or she might have missed the point because of a conflicting interest.

EL is a professor of neurology and a migraine expert based in Boston. She has several books on headaches – something we hadn’t thought to check before July 6.

She has been the President of and serves on the Board of the American Headache Society which runs an influential journal. She serves on the Executive Council of the International Headache Society, and the Board of the Headache Cooperative of New England. She has helped write all manner of guidelines for treatment of migraines, and has chaired the “Choosing Wisely Committee” of neurologists.

Knowing this might have affected how we worded things.

Dr Loder has been with BMJ since 2006 and declares that she has no links to pharmaceutical companies since then. She declares she has previously been a speaker, received grant support, or been a consultant for: OrthoMcNeil, Endo, AstraZeneca, GlaxoSmithKline, Pfizer, and Allergan – a list of companies that overlaps with one that formed part of my conflict of interest statement as of that point in time.

Before moving to BMJ, in a 2003 paper she co-wrote about how we don’t need to be so afraid of using triptans, it says both authors have gotten research grants and done speaking on behalf of various migraine medicine manufacturers including GSK.

Imitrex – sumatriptan – is GlaxoSmithKline’s triptan. With Imitrex off patent, GSK turned to Treximet, a combination of sumatriptan and an NSAID that was approved for migraine in children over 12 in May this year.

Sumatriptan comes with a suicide problem. Robert Gibbons has been enlisted to pooh-pooh this.

“you haven’t failed sumatriptan till you’ve failed to respond to a full dose of injectable sumatriptan given early in the migraine. That’s my mantra!”

She squeezes in that “there’s evidence it’s more effective when taken with an NSAID” – just before Treximet came out.

While Dr Loder’s name is not listed in OpenPayments or Dollars for Docs, a regular partner on much of her work is Stephen Silberstein. They are on all the same Influential Committees. Dr. Silberstein comes close to being the KOL’s KOL in the headache field. Here is a recent Disclosure Statement.

50 shades of gray

Meanwhile in addition to helping articulate BMJ’s position on conflicts of interest, Dr Loder was involved in a Lown Institute Twitter Chat in July on conflicts of interest, where she makes clear we need to find out more about non-financial COI’s.

Her BMJ COI statement refers to her husband’s position in a law firm but she states that he does not have a healthcare involvement.

His law firm is the Boston based Ropes and Gray.

John M Loder is not in the Healthcare division of Ropes and Gray. He is in Hedge Funds, Investment Advisors, SEC compliance. Attorneys from Mergers & Acquisitions, Government Enforcement, and White Collar Defense divisions likely work with GSK every day of the week.

Central to the work Ropes and Gray do is a First Amendment commitment that horrifies those who are usually most vocal about conflict of interest. This company is one of the main supporters of off-label marketing, on the basis that to prohibit it would be an interference with free speech. They have achieved some success in these areas. Their position makes a certain amount of sense to me.

The irony was that BMJ were using a close to monopoly position to abuse our First Amendment rights in respect of Restoring Study 329. If we had the money, the perfect people to have hired to fight our case against BMJ would have been Ropes and Gray.

But more to the point Ropes and Gray are currently GSK’s lead attorneys on company fraud matters in China. Their ties to GSK are close enough that journalists describe them as “GSK’s law firm in Hong Kong”.

And for several years they were also central to defending GSK in the Department of Justice and related investigations that led to a $3 billion fine for GSK in 2012. A key element to the charge against GSK lay in their handling of Study 329.

Colleen Conry and Brien O’Connor, co-leaders of the Ropes & Gray government enforcement practice, were successful in winning an acquittal for former GlaxoSmithKline associate general counsel Lauren Stevens in the U.S. District Court for the District of Maryland back in 2011.

Companies and individuals worldwide turn to Ropes & Gray’s leading government enforcement practice to guide them through all manner of investigations, enforcement actions, and compliance issues. Our attorneys understand business and regulation and help our clients pre-empt, resolve or mitigate the impact of government investigations and enforcement actions.

A radical suggestion

Around the time of Fiona Godlee’s July 6 email, BMJ suggested that the entire data from the study be re-analyzed by a third party who had no prior contact with the issues. This would likely have taken a further year at the very least.

This was plain bizarre.

Intriguingly, Elizabeth Loder and I had both attended a Selling Sickness conference in Washington in February 2013, and in her account of the meeting in BMJ a few weeks later she floated a very similar proposal.

“It would be hard to collect a more fascinating bunch of topics or people in a hotel conference room. The 2013 Selling Sickness conference recently held in Washington, DC was among the most thought provoking and just plain interesting conferences I’ve been to in a long while, and I go to a lot of conferences. This third conference in a string of international conferences was characterised by its organizers as part of “a global reform movement” against the “marketization of health, the corporatization of healthcare, and the hijacking of patient and consumer language to disguise market interests.” Opening speaker Shannon Brownlee identified “the different heads of the hydra” as “disease-mongering, conflict of interest, and overdiagnosis.” In her view, the challenge of this meeting was to identify these aspects of selling sickness and “weave them together in a systemic movement that promotes systemic changes.”

“I participated in a roundtable discussion charged with examining the news and communication perspective on disease-mongering, and was joined on the journal side by Jocalyn Clark of PLoS Medicine. Moderator Gary Schwitzer of HealthNews Review and panelist Nancy Shute [http://advanced.jhu.edu/faculty/view/?id=744] considered the problem from the vantage of medical journalists. When it came time to examine how medical journals might address their role in selling sickness and disease mongering, I suggested two possible strategies.

“First, why not quarantine apparently ground breaking studies about new treatments or interventions in a special journal until the findings are replicated and long term consequences explored? Print copies of the journal would arrive in plain brown wrappers which undone would show the journal’s cover logo of a skull and crossbones. During quarantine, any news stories or summaries of research from this journal would travel with a sternly worded disclaimer, along the lines of those that accompany investment company advertisements. Something like the following would do nicely:

“Warning! Taking any action on the basis of this research could result in injury or death. The results described in this study have not been replicated and the long term effects of this treatment are unknown. Past performance is no guarantee of future results. When subjected to further investigation, most published research findings turn out to be false.”

“To fill the void, medical journals deprived of these sensational research studies could instead devote themselves to the promotion and prioritization of the less glamorous medical research that really matters: replication studies, comparative effectiveness trials, and long term pharmacosurveillance and safety studies.

“My second suggestion was that several parts of a typical research paper are too important to be written by the researchers or anyone else with a vested interest in the outcome of the research. These include the portions where “spin” is mostly likely to enter into the paper, namely the title, abstract, results, and conclusion sections, and any summary or “what this study adds” statements that authors are now sometimes asked to supply. These portions of research papers should instead be written by disinterested parties with subject matter expertise.

“I have no illusion that these things will come to pass but I can dream, can’t I?

“During the question and answer session fellow panelist Nancy Shute turned to me and said “I’m impressed by your radicalism.” I’ll take that as a compliment!”

****

One can wonder if Dr Loder ever suggested anything like this for any of Dr Silberstein’s articles, or GSK linked articles involving treatments for migraine.

While a suggestion like this didn’t appear formally in the correspondence between RIAT and BMJ, it was raised in behind the scenes negotiations.

Access to the data

On July 8, RIAT sent an email to Fiona Godlee outlining some of the points made above. There was no response.

Have conflicting interests had an effect in this case? There are data that can be consulted.

When finally published Restoring Study 329 came with a number of tabs, one of which is labeled Reviews. As of this year it is BMJ’s policy to publish the reviews of articles along with the article.

One of the first Rapid Responses to the article was from Elizabeth Wager, a medical writer who has previously had close links with BMJ and who had reviewed previous articles about Study 329 submitted to BMJ that did not get published. She asked where the Reviews were. There was no response from BMJ. I submitted a response to her letter indicating that the reviews were available in their entirety on Study329.org. BMJ did not publish my response.

RIAT re-sent the July 8 letter to Fiona Godlee on September 30. We have had no response.

My impression is that most people reading the entire correspondence on Study329.org between RIAT and BMJ (mostly Elizabeth Loder) will agree that it shows an extraordinary level of difficulty. At several points the RIAT team came close to reaching the end of the line. The correspondence makes clear that some of us seriously entertained the view that BMJ did not want to publish. By July 6 we were exploring publication options with other journals.

In my opinion very few people will think BMJ were not biased by something. You don’t have to trust me – you can access the data and make your own mind up. Against this background, Elizabeth Loder’s competing interests will raise eyebrows for some.

Not tonight. I have a headache

Did John Loder’s involvement with Ropes and Gray cause our problems? In my opinion, no.

Did Elizabeth Loder’s headache expertise cause our problems? In my opinion, no. She was finicky but could have been a lot more finicky than she was.

The strongest evidence I have as to why there was such an unconscionable delay is that BMJ have been and still are scared close to shitless about publishing anything that might make a pharmaceutical company uncomfortable.

They have no problem publishing a Beasley et al paper that shows an increased risk of suicidal behavior on Prozac but claims there is no risk and that the data exonerates Prozac. They have no problem publishing Lu et al in 2014 that claims to show warnings on antidepressants cause suicide – a shoddy piece of work if ever there was one.

Ironically providing access to the data seems to have increased BMJ’s difficulties. A key message from Restoring Study 329 is that when data is made available all authorship (interpretation) becomes provisional. Despite apparent support for access to data, The BMJ want science to be authoritative – Biblical – rather than provisional. If an article offers the indisputable Word of God, they can’t get sued. If there is scope to read the matter in another way as David Linden’s Response to Restoring Study 329 indicates there is and always will be, the BMJ and their lawyers have a problem.

In my experience journals run by ex-pharmaceutical company employees have been much more courageous than BMJ on matters like this. However, while they appear to have lied at least twice in the process, BMJ are a long way from being the worst in terms of courage and integrity – they do, though, take some beating in terms of prissiness.

What was galling about the exercise was that BMJ (and everyone else who colludes to put BMJ and other journals in this position) see fit to turn their lack of guts around and blame our conflicting interests.

This is to be expected from people who have themselves been abused or are living in an abusive situation. Medication Time.

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Comments

It’s a tangled web and shows how moderation of comments, in this case from the BMJ website, can lead to yet more questions being asked.

Incidentally, I left a comment on the RIAT study via the BMJ website – it was never published. I was given no reason. I assumed it was because I wasn’t an ‘academic’ yet the BMJ invited me to the telephone conference with some of the RIAT authors.

Ropes & Gray have appeared on my radar, as you say, they were hired during the recent Chinagate scandal, a scandal that saw the (ahem) mastermind of that scandal, Mark Reilly, receive a suspended prison sentence. Meantime, PI’s (hired by Glaxo) Peter Humphrey and his wife, Yu Yingzeng, were incarcerated for nigh on two years (both now released)

It would appear that the BMJ are not being transparent here and when questioned they take the classic stance – say nothing.

Funny you should mention that Bob! Yes, they do publish comments from non-academics. I know because I have had two letters published, both in 2014. There were also a couple of really compelling letters published re: the Study 329 re-analysis: one from a “teenage Paxil survivor” now in her late 20’s, and one from a bereaved parent.

However, I posted one recently in support of a study I thought made some good points: a plea/demand for raw data from a group of GPs. They’d started out with a very good straightforward question: What drugs, if any, are worth taking for people in the community with mild (not disabling) Congestive Heart Failure?

None of the published studies supporting this or that drug broke down the responses according to severity of the patient’s condition — and they could get no further data or helpful responses from any of the authors. As a result, they concluded the current official guidelines are pretty close to useless. In an earnest & wonky way they made a pretty strong statement.

So far the BMJ has not printed ANY “rapid responses” to this excellent paper. I submitted one Saturday afternoon; it’s now Wednesday afternoon. Mine was written from the point of view of a former research subject who fully supports the sharing of raw data and thinks the concerns about my “privacy” are rubbish.

One point I raised was to question the sincerity of Pharma spokespeople sweating over the privacy issue … and at the same time churning out studies based on private insurance data, which is the most radioactive personal data any hapless American patient can offer up! And without consent of any kind that I can see. I have to wonder if the BMJ is holding up my letter because that point makes them nervous (they have printed such studies, and really crappy ones too as David points out) … or if there are other responses even more inflammatory that they’re still dithering over?

Study329 is the most important analysis as to why we swallowed it and what happened to us with it, after it, evidence of malfunctioning chemicals.

Seroxat can be lethal, we can attest to that.

Therefore, everything about this should be broadcast to the nation and health mags should behave themselves and respond without showing up their naivety, immaturity, senseless splitting hair mentality and realise that being a parent means being a parent and not a situation whereby GlaxoSmithKline can kill them off ad infinitum….

Does that interest anyone, or, is this being unfair to Ropes and Gray….

ANNIE>>> great link, but it got me thinking about what Witty said there at the end: “universities doesn’t publish all their failed research, nor do other scientists, but we (his beloved GSK, the allmighty transparency champion) do.”

Did he just forget to mention that other scientists or universities does not sell the Product of their failed research?
That a scientist that fails one experiment has to continue experimenting until he has a Discovery to show the World?
Perhaps in the hands of a real scientist, Seroxat would’ve never left the drawing board.

Instead they start Selling seroxat, and 25 years on trying to explain what the invention of theirs is doing to the human brain……
And their explanation is to use rigged trials as GOOD examples.

And it’s still up to ME to bring forward evidence that they know this is a harmful drug.
They have all the Money, but they can’t still produce a single shred of evidence that their Product is safe, other than hoaxed scientific jibberish.
//Ove 2015

Yes Annie – wouldn’t it be interesting to know what went on beforehand as, not only did Evan Davis not mention psychiatric meds., but neither did any of the questions! I doubt that it was a true reflection of audience participation. Maybe they’d been thoroughly checked out before entering – just incase there was a ‘conflict of interest!

We will force you to tone it down, or better still just go away; but if you persist, we will have to publish it, as we cannot be seen to be scared of a very powerful corporation, even though, from then onwards, we will be changing our underwear every time the phone rings…

The word craven springs to mind.

Sightly off topic, from today’s Lancet Psychiatry:

“Biomarkers are urgently needed…” (yet again, so that we can reverse-engineer them onto our DSM/ICD books of nonsense. So if you have any spare ones lying around in your garage or your shed, please give generously to these needy academic psychiatrists).

“Development of drugs for the treatment of the clinical symptoms and cognitive deficits of schizophrenia is unsatisfactory, with many initially promising compounds not showing beneficial effects in clinical studies. Experimental model systems of schizophrenia combined with well-validated biomarkers are urgently needed to provide early indicators of effectiveness. Herein, we argue that experimentally controlled sleep deprivation represents a translational model system that can be studied in combination with neurocognitive biomarkers. Specifically, we review data on the psychotomimetic effects of sleep deprivation in healthy human beings and provide evidence of the psychosis-like deficits in translational inhibitory biomarkers—prepulse inhibition and antisaccades—that occur after sleep deprivation. These data support the use of the sleep deprivation model in combination with biomarkers with excellent psychometric properties and well-characterised neural mechanisms, such as prepulse inhibition and antisaccades, to substantially advance development of drugs with antipsychotic or pro-cognitive effects”.

I have no idea what all of this bulls*** means, but I do know that I become intensely psychotic if I am sleep-deprived, and I suspect that I will then prepulse my inhibitions and translate my antisaccades, just like anyone else. But they won’t be trying any of their antipsychotics on me…stuff like this would be funny, if it didn’t have drug companies waiting in the wings to capitalise on it.

Jee-zus H. Christ! Yes, it’s true–sleep deprivation is a pretty damned reliable way to produce psychosis. No matter what your “biomarkers” may be. So is solitary confinement. Ain’t it great, then, that people who are susceptible to psychosis get treated with so many drugs that can cause … insomnia? (And then thrown into seclusion when they’re just too disruptive?) This is true of some of the anti-psychotics, and even more so with antidepressants.

Actually, for those who want to study psychosis, the classic way to produce it has been with amphetamines. Ah, but now amphetamines are therapeutic aren’t they? More and more of us are born with an amphetamine deficiency! I know docs who regard the very notion of Adderall addiction as some sort of New Age alt-medicine hysteria. So even in the lab, I guess, they couldn’t bear to use a Medicine to make the subjects crazy.

The greedy nefarious tentacles of Bi Pharma have all but strangled the very idea of ethics out of medicine altogether…

Big Pharma has a huge influence upon how the ethics work (or don’t work) in medicine, academia, the psychiatric profession, the regulators, universities, some patient groups, and health-care in general…

However, dodgy though this is, and it is undoubtedly so..

What’s even worse is- those who are under this influence are in complete denial about it..
That’s the real danger..
The worms in the can don’t even realize that they are the worms in a can..
And the can is literally crawling…

What is it with these People in Power – does the very post of ‘a very important person’ turn their heads so much that common decency does not apply anymore? I refer to the notion that, on receiving a letter or email that you disagree with, it’s acceptable to ignore it. Where I come from, the least you should do is reply to it. Ok, maybe the recipient won’t necessarily like the reply but getting an acknowledgement of the fact that you had written in the first place is a good feeling in itself – after all, we’re each of us allowed an opinion and have the right to express it.
Soon after Restoring Study 329 was published, I wrote to several MPs and Lords drawing their attention to its importance etc. and wishing to know how they intended bringing the contents to the notice of the public in general. I added a paragraph about the heavy cost of medications to the NHS, the unnecessary suffering by so many people of all ages and the cost of this to the Welfare system.
I did this because I felt a sense of duty to do so as a mark of respect to all who have suffered by the hands of the ‘big pharma’ companies and in support of those who try so hard to make things better in that field. ‘Surely’, I thought, ‘the least they can do, on receipt of their letters, is acknowledge the fact.’ Guess how many ‘acknowledgements’ or replies came? ONE – and that was from our own MP! Feeling that it’s ‘safer’ to do nothing shouldn’t be an option in my book.

The *support group* for transgressors of their oath is exceedingly fascinating. Especially, I notice, in the area of secrecy, which brings in the common human dominator. Perhaps, on a purely subconscious level, the web operates as one entity that conceals the evidence of harm as an essential component for its survival.

If such a web is obscenely wealthy, the law of attraction will supply it with enough unwitting lemmings to form the foundation for a global economy!

Pharma has infected every nook and cranny of health care. From the top to the bottom it’s soiled and corrupt.
I was sitting in a hospital waiting room not long ago waiting for my son to come out from his appointment. Waiting to see if his visual field defect had worsened. The defect that appeared on SSRIS. I was staring at a poster on the wall. It was telling patients they shouldn’t use willpower to stop smoking as they would ultimately fail. They should use drugs. At the bottom of the poster sat proudly alongside the NHS logo was the Pfizer logo. Pfizer the reason my son was in the consulting room.

Pfizer can’t prescribe their wizbang drugs. Like many health care professionals who reach out to doctors, from the prominent academic KOLs to those in our backyards, seeking a rational strategy for reclaiming the integrity of medical practice, I receive no responses. I’m sure I am barking up the right tree. what gives?

I am not the least bit surprised nor am I interested in the tried and true tactics of fraudulent business practices. What is alarming and deeply fascinating is the silence from what one would hope is the majority of doctors whom, one would expect, are outraged by the absence of science in their literature, and more importantly in the guidelines for treatment, that have replaced medical expertise.

Hoping this is just the calm before the storm — and that a new day is about to dawn.

LISA>>> The other day I had one of my 6-months checks with my psychiatrist.
Beneath her desk, tucked away against the wall, was a small paper bag. Like the ones you see in womens accesories stores (for make-up and whatever)
This one was Bright White, with string handles, like woven strings.

On the side it said: “helping brave people get braver, and well, SHIRE”

(SHIRE, is big pharma, perhaps less known than others)

(the quote isn’t Word for Word, but very similar)

Could it have been a hotel-weekend?
Fancy drinks?
“Networking”?
“Speeches”?
Further education?

These glamour gift bags are also given to nurses who attend “free” gourmet dinners hosted by pharma–All that is required of the nurses is submission of an evaluation form, confirming their attendance at the mini lecture given by a pharma rep. – the reward? free continuing education units ! Why would a nurse choose any other forum for professional enhancement/education?

I can only speak for myself, as a nurse who has a fair collection of pharma souvenirs, and certificates of CEU– enough to paper the walls of a banquet hall. Something very rotten was happening to my patients (nearly all children/adolescents), and not a single MD, pharma rep. or medical management administrator invested their time and energy to get to the root of the problems–that patients exhibited–ONLY AFTER TAKING PSYCH DRUGS.

Speaking only for myself, the only logical course was seeking information outside of the Harvard network– Between the HMS Conway Medical library and Google, I had a gold mine of info in less time than it took to force me to resign. Bob Whitaker used the Conway library, BTW– and like me, he has a *no trespass* order from HMS. (Conway, consMedical School, right next door to Boston Children’s Hospital)

So, you see, it does not take a great deal of effort, or even an inordinate amount of education going into these matters–Seems like all that is required is CONCERN– or for me, frantic worry over something of primary importance– for me, children. Patients suffering adverse effects do this sort of sleuthing all the time–.

So, rather than wondering what is on your psychiatrist’s pharma emblazoned glamour bag, I would worry what is in her head, and look for evidence of a conscience or a heart…

Considering the bare minimum required of providers of cookie cutter sham medicine, — you could be daft and lazy and still make a handsome profit practicing market based medicine.

I’d like to see the scammers having to make their full living wage off of pharmas hand outs–. I think it is a crime that the patient has to pay to be disregarded– and or waste their precious health care insurance –supporting these sloths — no matter how glamorous they look!

My guess is that what happens in Boston, is replicated here (small Town, nowhere, nowhere, Sweden) on a slight smaller scale.

Of course I agree that nurses get further education, and even a gift bag to some degree, they aren’t paid good enough to start with. But Physicians are paid very well. Any influence on a physician, (GP, Psychiatrist, MD) is a bribe and fraudulent behaviour. At least there should be a fine for that.

Well, if you have seen how the Children comes in second to the professionals careers and earnings, then I can easily see why you are so Active on this site and others.

And perhaps info isn’t hard to come by, if you know where to look, but I feel so alone in my quest for information. To some degree it is still a daunting task for me, that I had never pictured was likely to be needed for me. I trusted my representatives and government to keep my Pharmaceuticals corruption free.

Pharmaceuticals and what is considered good nutricious food, I thought were two areas where corruption did not occur.

No, I won’t waste time trying to find a heart, nor her mind, of my psychiatrist. The “grin” she showed me, when I told her that tapering off Paxil was too hard for me, was enough to understand her imagined superiority….

Patrick Vallance on ‘The life scientific’ this morning on Radio 4. ‘All Trials’ came up, and Study 329 was briefly discussed – GSK come across as humane, far-sighted, and benevolent…wow.

But no mention of the forthcoming whitewash (oops, I meant ‘results’) of the SFO investigation into the ‘sex tape & prostitutes’ affair of GSK China.

At the end, when Jim Al-Khalili asked him if he now missed ‘the science’, his reply was that, on the contrary, he was now ‘immersed in science’. The man seems very bright and well-educated – how can he possibly mistake something brown, sticky and very deep for ‘science’?

I’ve just listened to that episode on The Life Scientific too – here’s the link, if anyone is interested.

My guess is that Patrick Vallance is one of GSK’s new public faces: calm, reasonable and oh so reassuring. He skirted very skilfully over the matter of study 329 – either he’s always been a smooth talker or GSK has put him through some strenuous PR media skills training.

You wonder how he can have muddled science and dog shit – I imagine the size of the salary/perks package had a lot to do with it? A fact that was missing from his description of the dinner party when GSK made him an offer he couldn’t resist….

“Patrick Vallance is something of a rare breed: a game-keeper turned poacher; an academic who’s moved over into industry”.

When did game-keeper come to mean someone who acts as a lackey, or serf, to the poacher? Who on earth wrote this byline? Don’t they know where academics obtain their funding? After all, Patrick made a big deal about how GSK opened up the facilities at one of their labs to academics…

Great minds and all that….I was thinking about illusions of grandeur, yesterday

Q: When did you realise that you could rise up the ranks and become a big fish?

A: I realised I was capable of ingesting huge swathes of scientific information and that I could talk, and talk and talk without stopping…I could talk the talk well into the night, I could keep talking….I could move my arms around like a deaf interpreter…I thought I could become powerful

Q: I have noticed that you have not a great deal of inflexion in your lengthy talks; it seems sort of flat, have you always talked with your foot turning on its edge?

A: My foot is not really a part of who I am, my foot is like your foot, and our feet are maybe happy feet

Q: Are you a popular sort of person?

A: Who isn’t popular, dressing well, clean and wholesome, well educated, what’s not to like?

Q: I suppose you won’t want to give me a scoop today and talk about Seroxat

A: I will talk about Seroxat long into the night, I will talk about Seroxat until the cows come home, I will talk and talk and talk…my arms and hands and fingers will show you we have helped the world overcome their diseased minds….how long have your got?